Dr. Tilak Mendis

The applicant sought income replacement benefits (IRBs) beyond the 104-week post-accident mark, requiring him to prove a complete inability to engage in any reasonably suited employment.

The respondent insurer denied the benefits, relying on surveillance evidence and expert reports suggesting the applicant had some capacity for work.

The Tribunal found the applicant's testimony, corroborated by his spouse and medical evidence, established that his chronic pain and severe psychological impairments prevented him from sustaining employment.

The Tribunal placed significant weight on the applicant's experts and found the surveillance evidence did not contradict his reported limitations.

The applicant was awarded ongoing IRBs and interest on overdue payments.

The applicant sought a determination that she sustained a catastrophic impairment under Criterion 8 (mental and behavioural disorders) following a motor vehicle accident.

The Tribunal found that while the applicant sustained a mild neurocognitive disorder and a specific phobia as a result of the accident, her impairments in activities of daily living, social functioning, and concentration, persistence and pace were only moderate (Class 3).

Although the applicant demonstrated a marked impairment (Class 4) in adaptation, the Tribunal concluded this was caused by severe pre-existing psychological limitations rather than the accident.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's denial of treatment plans for a neurological assessment, psychotherapy services, transportation costs for an orthopaedic assessment, and physiotherapy services.

The Licence Appeal Tribunal found that the neurological assessment and physiotherapy services were not reasonable and necessary, relying on insurer examination reports and the lack of objective improvement from past treatments.

The Tribunal also held that the applicant failed to justify a higher hourly rate for a psychotherapist and did not provide evidence of incurred transportation expenses.

The application was dismissed in its entirety.

The applicant sought statutory accident benefits following a motor vehicle accident.

The respondent insurer determined the applicant's injuries fell within the Minor Injury Guideline (MIG) and denied treatment plans for physiotherapy and psychological services.

The Tribunal found that the applicant sustained a concussion and post-concussion symptoms, which fall outside the definition of a minor injury, thereby removing him from the MIG.

However, the Tribunal dismissed the claims for the specific physiotherapy and psychological treatment plans, finding the applicant failed to demonstrate they were reasonable and necessary.

No interest was awarded.

The applicant sought income replacement benefits (IRB) and two treatment plans following a motor vehicle accident.

The respondent denied the benefits, relying on multiple independent medical examinations.

The Tribunal found that the applicant met the tests for both pre-104 and post-104 IRB, as he suffered from a substantial inability to perform the essential tasks of his employment and a complete inability to engage in any employment for which he was reasonably suited.

The Tribunal preferred the evidence of the applicant's experts, noting that the respondent's assessors evaluated the applicant in silos and failed to provide an integrated assessment of his physical and psychological impairments.

The treatment plans for chiropractic services and a psychological assessment were deemed reasonable and necessary.

The claim for an award under s. 10 of O. Reg. 664 was dismissed, as the respondent's conduct was not found to be unreasonable.

The applicant sought income replacement benefits (IRBs) and a special award under Regulation 664 following a motor vehicle accident.

The respondent insurer denied the benefits, arguing the applicant's impairments were based on subjective complaints and her evidence was unreliable.

The Tribunal found the applicant credible and determined she suffered a substantial inability to perform the essential tasks of her pre-accident employment as a gas bar attendant, entitling her to pre-104 week IRBs.

However, the Tribunal dismissed her claim for post-104 week IRBs, finding she failed to prove a complete inability to engage in suitable employment, as she had successfully worked part-time jobs post-accident and failed to prove her subsequent surgeries were accident-related.

The claim for a Regulation 664 award was also dismissed, as the insurer's delay in obtaining addendum reports was not unreasonable given the applicant's delay in providing requested documents.

The applicant sought a non-earner benefit and funding for physiotherapy following a motor vehicle accident.

The adjudicator found that the applicant failed to prove she suffered a complete inability to carry on a normal life, as she continued to engage in substantially all of her pre-accident activities of daily living.

Furthermore, the adjudicator concluded that the proposed physiotherapy was not reasonable and necessary as a result of the accident, accepting expert evidence that the applicant's accident-related injuries had resolved and her ongoing issues were due to pre-existing osteoarthritis.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including chiropractic services and lost educational expenses.

The respondent insurer denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG), and sought repayment of an overpaid income replacement benefit (IRB).

The Tribunal found that the applicant's ongoing neck and back pain, supported by clinical records and the respondent's own assessments, took his injuries outside the MIG.

The Tribunal approved the treatment plan for chiropractic services as reasonable and necessary.

However, the claim for lost educational expenses was dismissed because the applicant failed to prove he was unable to continue his automotive training program as a result of the accident.

The Tribunal also ordered the applicant to repay $2,800 in overpaid IRBs, as he had returned to work during the period in question.

The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement benefits (IRBs) and the cost of a neuropsychological assessment.

The respondent insurer had terminated IRBs, alleging the applicant failed to provide requested income information, refused to answer questions at an examination under oath (EUO), and made a material misrepresentation about his employment status.

The Tribunal found that the applicant suffered a substantial inability to engage in the essential tasks of his pre-accident employment as a web designer due to post-traumatic headaches and ocular motor dysfunction.

However, the Tribunal also held that the respondent was entitled to withhold IRBs from June 15, 2016, onwards because the applicant failed to provide reasonably requested income information and refused to answer relevant questions at his EUO without a reasonable excuse.

The respondent's claim for repayment based on material misrepresentation was dismissed.

The Tribunal approved the treatment plan for the neuropsychological assessment and awarded interest on a limited period of overdue IRBs, but denied a special award.

The applicant was injured in a rear-end motor vehicle accident and sought income replacement benefits (IRBs) and medical benefits from his insurer.

The insurer denied the benefits, arguing that the applicant's inability to work was caused by pre-existing psychological issues and not the accident.

The arbitrator applied the 'material contribution' test for causation and found that the accident materially contributed to the applicant's post-concussion syndrome, depression, and resulting unemployability.

The arbitrator awarded IRBs for both the pre-104-week and post-104-week periods, relying heavily on undisputed vocational expert testimony that the applicant was completely unemployable.

The arbitrator also awarded the claimed medical benefits and ordered the insurer to pay a special award of $30,000, finding that the insurer acted unreasonably in continuing to deny benefits despite overwhelming evidence of the applicant's accident-related impairments.